Portal biliopathy
Updates to Article Attributes
Portal biliopathy refers to biliary obstruction that is associated with cavernous transformation of the portal vein due to portal vein thrombosis 1.2.
Clinical features
It may present as jaundice, cholangitis due to bile duct obstruction, or rarely as haemobilia.
Pathology
When portal vein thrombosis occurs multiple venous collaterals develop to bypass the obstruction resulting in portal cavernoma and peribiliary collateral vessels. The peribiliary collateral vessels cause extrinsic compression of the intrahepatic and extrahepatic bile ducts.6
There are also underlying inflammatory and ischemic changes resulting in peribiliary fibrosis.6
Portal biliopathy may be classified as varicoid (obstruction by large collaterals), fibrotic (from intramural (epicholedochal) collaterals seen as thickened and densely enhancing bile ducts) and mixed type.6
Radiographic features
MRI - MRCP
MRCP features of portal biliopathy in order of frequency is as follows:
- biliary stenosis
- wavy appearance of the bile ducts 3
- angulation of the CBD
- upstream dilatation of the bile ducts
Differential diagnosis
Possible considerations include
-</ul><h4>Differential diagnosis</h4><ul>-<li>cholangiocarcinoma</li>-<li>sclerosing cholangitis</li>-<li>choledocholithiasis</li>- +</ul><h4>Differential diagnosis</h4><p>Possible considerations include</p><ul>
- +<li><a title="cholangiocarcinoma" href="/articles/cholangiocarcinoma">cholangiocarcinoma</a></li>
- +<li><a title="Sclerosing cholangitis" href="/articles/primary-sclerosing-cholangitis">sclerosing cholangitis</a></li>
- +<li><a title="Choledocholithiasis" href="/articles/choledocholithiasis">choledocholithiasis</a></li>
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